Loading...
HomeMy WebLinkAbout006-1045-70-000 r n N O n N O !; v n v1 c °+ c °' �1 ro �1 m m m e m • d c ;o Z v, Z O W T Z 2 m Z ° o ° SD O O N O N cD O m N L7 N N �I • O `� • N °' a c m rn a O W N O CL m CD CD 0) m I m a C) a �'. m N� m Oo 0, A O N N@ su 3 N 3 N N (7 O O - 0 0 O S' tU N fD _ 00 3 a ! ° CD I ° 7 N N 7 N CD! d O O Lf <D w n < D m a o' z D ,� a (D N to C ^' :G7 O N d cn � C" " co o W N CD < �r o 0 o m CD cD o D v, CD c c00 CD O -4 -4 C (� O C N oo OD O o m L .. W CD CD N O O O v O O O I( Y ��• °_ n � c N y N� j• c f�/1 f�A N is o :T o O !I O CD cD N Ut (D . N @ Ul CL O1 N v 3 !!1 N O . N A W N O Z I o z 'Y ?O z zcoz o =� D D o D o 0 N 0 0 C o ° m m C CD A O N N N n n N � �f O N O C (D W CL N (D I z CD CD O Cl) N c r _� Z O C) a P. O 0 Z j N co m W � a a , — z 0 3 0 3 - - a 0 o rt z a, y N z :I N O I ? W U W N D 3 CD CD a CL CD ? x fD N V O T 'O O? O= T -4 m ° z a m Z o 0 3 0 0 N N 7 (Q N cD N Q CD 3 3 .Z I 0 : - , O y O ° Q 4 N N ` CD N fi 0 n !I lv C/) N V O N 7c O O _ V N (D Oq 0 0 0 0 0 a o � o Q Parcel #: 030 - 2116 -40 -000 05/14/2007 04:52 PM PAGE 1 OF 1 Alt. Parcel #: 31.30.19.961 030 - TOWN OF SAINT JOSEPH Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner O - WHITE EAGLE GC LLC WHITE EAGLE GC LLC 369 E KELLOGG BLVD ST PAUL MN 55101 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 31.550 Plat: 2612 -WHITE EAGLE 1 99 SEC 36 T30N R19W E1/2 NE1 /4 OUTLOT 5 Block/Condo Bldg: LOT OL5 WHITE EAGLE Tract(s): (Sec- Twn -Rng 401/4 1601/4) 30- 30N -19W Notes: Parcel History: Date Doc # Vol /Page Type 05/25/1999 603764 1429/60 QC 2007 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/12/2005 Description Class Acres Land Improve Total State Reason COMMERCIAL G2 31.550 353,400 0 353,400 NO Totals for 2007: General Property 31.550 353,400 0 353,400 Woodland 0.000 0 0 Totals for 2006: General Property 31.550 353,400 0 353,400 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: 12/0411998 Batch #: PRGRM Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel #: 006 - 1045 -70 -000 06/27/2007 08:31 AM PAGE 1 OF 1 Alt. Parcel #: 21.31.16.315 006 - TOWN OF CYLON Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner O - KJELLBERG, KELVIN A KELVIN A KJELLBERG 2205 210TH AVE DEER PARK WI 54007 Districts: SC = School SP = Special Property Address(es): " = Primary Type Dist # Description 2205 210TH AVE SC 3962 NEW RICHMOND SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Legal Description: Acres: 40.000 Plat: N/A -NOT AVAILABLE SEC 21 T31 R1 6W 40A NW NW Block/Condo Bldg: Tract(s): (Sec- Twn -Rng 401/4 1601/4) 21-31N-16W Notes: Parcel History: Date Doc # Vol /Page Type 07/23/1997 1138/246 WD 07/23/1997 942/315 07/23/1997 797/140 2007 SUMMARY Bill #: Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 07/26/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.000 15,000 187,500 202,500 NO AGRICULTURAL G4 24.000 3,400 0 3,400 NO UNDEVELOPED G5 1.000 100 0 100 NO AGRICULTURAL FOREST G5M 13.000 15,600 0 15,600 NO Totals for 2007: General Property 40.000 34,100 187,500 221,600 Woodland 0.000 0 0 Totals for 2006: General Property 40.000 34,100 187,500 221,600 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: 0411712001 Batch #: 512 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 I 4 0 (D ° a o M 0. O � N � U I C @ Lo O N ` co N O N f0 O N y Nzr a� ! Oa f6 4/ N 7 I M y r O 3 2 L z M a_ N L Lo vas CS M O @ c 'C ,� M .� � o O v @' O 3 O `oa 0 h 3 o C'O y M �. @ N O N ` 0 -0 y @Y 00.0 z � I y N . o y O � -0 I c - am a O N C O CD LL _ c - E- N L o E 7 5 C C c +-' U 'O Q1 �-' O U E >- N 't7 O y 3 N N O@ E Q U S O N y o c- c) � a CO LU N z ; O n H z II I , a m c O j c z O U Q O fq F- O7 d O r Cl) N 7 y � c •� a M O 0 a @ z m z N z jo d c E N Lo l6 w , d y ' S C .5 .�.. @ C Y H d ti N L O coca acn - d N N N j �w u ° 0° z 0 O O O 0 1V d d d 0 N QT - C N y !n U o O N } O O N M O N z 'E @ O @ d j cd y 7 H O w c O E O O C N c V 4 p L a-- N 30 y C M Q) N D M O I - @ c 7 7 N try�,]r E M art N w "O V) a) 10 co t 3 � c L. ° O U (D d O y z d U) ~ i Y # d ti d CD Q U w C rr d C @ 7 I : y Q _1 A 0I LMI'0U)0 , Parcel #: 006 - 1045 -60 -000 06/27/2007 08:31 AM PA 1 OF 1 Alt. Parcel #: 21.31.16.314 006 - TOWN OF CYLON Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner O - REISS, NORMAN J & JUDITH L NORMAN J & JUDITH L REISS 360 SOUTH ST W DEER PARK WI 54007 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description SC 3962 NEW RICHMOND SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Legal Description: Acres: 40.000 Plat: N/A -NOT AVAILABLE SEC 21 T31 R1 6W 40A NE NW 174 201 T AVE Block/Condo Bldg: DEER PARK Tract(s): (Sec- Twn -Rng 401/4 1601/4) 21-31N-16W Notes: Parcel History: Date Doc # Vol /Page Type 07/23/1997 947/335 07/23/1997 797/140 I 2007 SUMMARY Bill #: Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 07/26/2005 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 7.000 1,200 0 1,200 NO AGRICULTURAL FOREST G5M 33.000 22,900 0 22,900 NO Totals for 2007: General Property 40.000 24,100 0 24,100 Woodland 0.000 0 0 Totals for 2006: General Property 40.000 24,100 0 24,100 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: 04/17/2001 Batch #: PRGRM Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 00'0 00'0 00'0 lelol sa6Je4a;uenbullaa saBJe40 lelaadS s;uewssessy lelaadS ;unowd AJOBa;eO opoa leloadS aasn :sleioadS :# 4o1e8 :a ;ea uo13eol;lljeo 0 :;unoO wield :;lpajC) Ai allol 0 0 000'0 PUelpooM 0 0 0 000'0 ApedoJd IeJauaO :LOOZ Jo; sletol uoseaa a ;e ;S le;ol ano.idwl pue saJad ssela uol;dlJasea LOOZ /SZ40 :pa6ue4O Ise-1 :su011enleA 0 :4 ;Inn passassy :onleA;a3IJeW J!e:J :# Me J1uvwwns LOOZ 00 L6171 LV0 L L66 L /£Z /LO Z3 OL90t 90OZ /b L/Z L 00 UM79 9002 /tl L /Z L adA1 abed /IoA # ooa a ;ea :AjOlsIH IaoJed :sa;oN M9L-N8Z-EO ( d 1302Nd) 80d Ol l� Z0 *9VU 319S Hl'ld 89'L££ L 3.00N Hl '13 99'8t�Z L M (t7/L 09L b/L Ot 6uZl- unnl -oaS) :(s);oeJl 18N Hl'13 t M,98N Hl'13 09'£9£L M ,OOS Hl '13 8Z'999 3,99S Hl 'HOO t7 /LN :Bplg opuoaploole 038 3N MN ld'8 MN 3N id M9L2i N8Zl £ 03S 319VII dAV ION /N field L98'89 :salad :uol;dlJasaa leBe O11M OOL L dS Vg ]V 3111AdOOM L£ZO OS 3AV H109 gtt�t�Z . uol;duosea #;sla adAl uewud = , :(se)ssaippy A:pedoJd lelaadS = dS IooUoS = OS mowsla 8ZOt79 IM 3111A000M 3A`d H109 St�t�Z HonOO 3NI2OHiVO `dNNb 8 2jnHi2:]V NOSyf 3Nlb3Hlb'O VNNb"8 bjnH -UJV NOS`df 'H0f100 - O aaumo -oo juaimo = o 'jaumo 3uaiinO = p :(s)JaunnO :ssa.ippv xe1 0 00 9002 /b L /Z L adAl;Iwaad #;IwJad # uol;eallddb eeiy sales # deW a ;ea IealJOISIH WO uol ;eaJO NISNOOSIM 'A1Nf10O XIO2iO '1S X ;uenna 31Td0 nV3 d0 NMOl - 800 V L£'9 L' :# IaaJed 'IIV 6 d 0 L 30Vd wd LLZL LOOZ /sZ /90 5 ZO - OZ - 80U - 800 :# I aa.le d . C Y LO N POLK COUNTY T 31 N--R. 16 W 59 T� /e�so� iCfsc � d m _ C • 3c'�7� ��mo�7 P SOi� .SO�7 0 e.da . 86 4i • ' 9z • �/ �/ A `� � �z9 /Q /�d 84 qv m�� r� r /ro 9 ® / /ayd -- /76 Cho Ge�ha�f �aho /s fD ck- � F 7fio m s o Bo . h/erifB s s3 6e �4o � /GO � 0 /79 - l/�E'S • C /ask 4 C � g�� h / � O orde C � f��¢ ,Be•' El � � Via /et U b C (f � so � � Taff • /L 3.s 40 .B /ombc �\ �' /ems �� a/z2/ 170 ..... H /zo �o z 47 . /- 40 • /j'i7o // of /e .1/er✓fo� ¢o W , iii'" BE`ti 219' -d�i Palii'. ".�'"".' E: i tl: � • /.ZO � /zo ono /d .9 /ax � co effo •�. Le /7 i7e C ® ' G .��e� Thon�soii.:: Fish2�• • 40 • e% .S/ n 'Y6s T/ - �eo" //c �XJI i� p .� /07 /so f7 %,n 4 ¢o ✓e son U VI l /7'iio // �' /ue e 37 :::::::::::::: Q VI 80 ` ou.F z 40 � . ::ARK Osman Doe ' � hi, /e C Q l \ f/eibe f F /d, !✓d /¢n • C /¢n ":....._........ /s8 'moo tl R • 80 . ao Qo u �usf f iiiEE` €: sd�P C, BNIY 1 / e // c m P Wald tl H 39 ii. ::. ! Ea ..: ......... o.s z -Da /c X96 -ems pp 0 /z tl • "� Tab, "� Ma l' C't, B h 40 � /zo �' ea° . y� �� � CI � � ry � \ ry iba syUhn• go /zd s7 ���� •� �,,,e � � /,j. so o�i" / h ¢° ���0 � � � dbC�p f e es2 60 40 or 79 y 4a d C Se�fer ¢✓ �� � \ N ¢� ��07 �Sfq e f f uP� V moo �O/is. oun �y O/°� ' 4G 3 93.5• .eo �d .BUrYo one // Hansoms � � . C� //9 \ zoo e /a/ mimic c oc .C y 07 0j S /cwa../ so /zO "'� e k M¢ry Tot /se/' A / /ems E Fou.Es V l 41 �j 0 Toh� f7 !v /f Li / /ia Estes /ots � / 80 Bucto� 6° % 9 sa 170 .Robb �i-¢ce !7'0o r�cfj ne✓ ✓e o /Ue //2 h'oebe�/7 /e/r" tiro/ • ¢O 40 � o ✓de RIVE cT¢ckson z o0 W C /¢iz2 4 ¢O 6o do h ° kr rn Yabc. lT¢ Joe aE� Ed ,Po6P�f7> b � 60 � s /� 8o y o � //q �o o' E// s F� P'• �u J A /ma zoo 'Po i o f/. % /e.stad as 6 ec¢176&, d e z �o E / /edo V 3 80 l y� Ne / /ay Al 9 QT /93 ' (rack-, ¢ie fd ^ Garde \ cT¢mes efur X CO r �. /. /iB6 � J ene scan � a © � V � • . ¢O 0 y U �,� 6 • � .Dirt ¢n � Q \' Cl 0 � s ,L Mufua/ ¢° ��\ S ¢s iP.ch¢rd Ho airt P f - D 0 r 0 p ` cSc•h¢o/7 free,- ( c) O/s I d z �o 2 ti/¢ /fer eQ.• 6i1/e / /.e V Vv 2 C d l Osc¢r W U /a6 �' .moo /¢s cT ti: 41171. -d GP�fiude 3 ff¢ 17/7 V Q G/ea�n I>ou /QS ch ■ >5 Cjood / 70 zoo 6o zo \ yn E /oo� /eqq/ 64 ° © 73 Q m /� son Yar SPcrcer fLal/oXnc Diffm¢/7 Goo4 icf� � e� / ss.5/ d • 79 8 79 \) 3d CTQC.� •� \ � Q �¢y .z si 61 9 /cc l` Q E • l \ \ .zde so /8 /J ®o .Dons � • oZ�'� e¢�/f �A b � y C'a�v�cs l� � Q � J S S.. izJ G 9 o, -reds 0 U l O ' /9y /es Fo o 19,5;-s 7 • w F anecs �? �� C/ rd pQ TOmes ffi`f C¢sey Lfe.7 � ,Dori3 ` 'ate %y ffo �p S 90 SEE P,IG 45 SEE PAGE 47 PLAT BOOK COMMITTEE SALES COMMITTEE Cont'd. on page 61 Mr. James Ray Mrs. Charles Smith Mr. Jim Ruemmele Mrs. Gordon Mueller Mrs. Ross Pierson Mrs. Miles Casey Mr. and Mrs. Bob Phillips Mr. Robert Harer Mr. Al Franko Mrs. Guy Wilbur Mr. Don Matysik Mrs. Judy Ferguson Mr. and Mrs. Merton Vrieze Mrs. Joe Lohmeirer Mrs. Willard Johnson Mrs. Robert Gardner Mrs. Robert Hanson Mr. and Mrs. John Steele Mrs. Freida Fellinser Mrs. John Lavelle Mr. Robert Condon Mr. Leon Holle Mrs. John Glassbrenner Mr. Del Polzin Mr. Steve Thompson Mrs. Harlan Johnson Mr. LaVerne Karastes Wisconsin Department of Health and Social Services Plb. #67 3170 Divirton of Health SEPTIC TANK PERMIT APPLICATION TT?E or USE BLACK INK A. OWNER OF PROPERTY Name Address (Street, City, Zip Code) Mr. & Mrs. J. C. Reiss Deer Park, Wisconsin Be LOCATION OF PROPERTY WHKRE SYSTEM WILL BE CONSTRUCTED ALTERED OR EXTENDED COUNTY St. CrOL Check One: CITY VI E LEGAL DESCRIPTION NoWe 4 of Noy e 1 Sect. 21, Town 31.N, R16W 7 TOWNSHIP C. IS LOCAL PERMIT REQU ED FOR THIS WORK? % YES ::C ,9 PERMIT NUMBER D. SEPTIC TANK CAPACITY 1,000 Gallons NEW INSTALLATION x I REPLACEMENT ADDITION ltATERIALSt Prefab Concrete x Poured in Place Steel Other NUMBER OF TANKS 70 BE IISTALLED: eTe E. TYPE OF OCCUPANCY Cheek One: One or Two Family Residence x Cowmercial Industrial Other ( Specify) Number of Persons to be Accommodated 2 Number of Bedrooms 3 F. APPLIANCES, ETCt Food Waste Grinder YES x ' NO Automatic Clothes Washer YES 'A* NO Disho aher YES X_ NO Automatio Potato Peeler YES x NO Other (Specify) G. MASTER PLUI•'WER MAKING INSTALLATION Name: Wi l l i not fain Address Am�ry. T- Tisconsin License Number: MP 4995 r Signature of Applicants � �� -�' z.7 L /'��t_ MP R Addresss Amery, Wisconsin H. (To be Completed by Issuing Agent) Date of Application A-) Fee Paid, _ Permit Issued (date) /L - C� Permit Number 7 -?� Agent (Name) ��� �J For: ^ Town, Village, City, g9unty, etc. J (Specify) Note: The application cannot be considered for filing until all of the above n *:estions are answered and the fee paid. Agents wil- forward application, the fee of $1.00 _or each septic tanx and the third copy of the permit (canary) to the Division of Health. Checks and :coney orders should be made payable to the Division of Health. Do not write in space below - FOR DEPARTMENT USE ONLY I. DATE RECEIVED 1 1 - / / 7 jJ ACCEPTED BY RETURNED / (Initials) / (Date) See C,rresr FEE RECEIVED ✓ VALID. NO. a �- (/! PERMIT Noe es or No REVIEWED BY APPROVED DATZ (Initials) Yes or No COMPLETE OTHER SIDE SEPTIC TANK PERMIT NO. ~ REPORT O N SOIL P E R C O L A T I O N TEST AND SOIL BORINGS- TO DIVISION OF HEALTH PLUMBING SSCTItl P.O.Box 309, Madison, Wis. 53701 Pursuant`to H 62.20, ilia. Administrative Code P E R C O L A T I O N T E S T Test Depth Character of Soil Hours Water Test Time Drop in Water Level Inohes r utes Number Inohas Thickness in Inches Sinea Hole in Hole Into rval Second to Next to Lash Fall let Wetted cverni in Minutes Last Period Last Period Period , Inch Example P - 0 36 To Soil 10" Cla 26 °a 25 Yes or No 30 R 1/2 1 2 1 2 ou s?" .:S.6n,S Pcckl " — 4f3" • fiamt 4 no 30 4 2 2 15 4?" mar e 4 no 30 2 1.5 FIT 20 RECORD DATA FROM MINIMUM OF 3 TEST HOLES Compute size of absorption area in accord with H 62.20 Wis. Administrative Code - S O 1 B O R I N G S - Minimum 36 Below Pro osed Absorption System Boring Total Depth Depth to ground Water Depth to Bedrock Number 'L -&zht: Observed I Estimated Observedl Estimated Character of Soil with Thickness in Inches Example B - 0 72" 72" Black Top Soil 12 CIM 18"1 Sand 181 Gravel 24 84 unkr_a unknown T.9.6 ", sane & rac!k 1 ", annd --r c?a7760" RECORD DATA FROM MINEIRM OF 3 BORE HOD PE OF OCCUPANCY: RESIDENCE: Number of Bedrooms OTHER (Speoify) Number of Persons 2 POO WASTE GRLUDFRI Yes Na Dishwashers Yes No - •-.• tutomatia Clothes Washers Yes No FFWENT DISPOSAL SYSTEM: NEW X EXTENSION ADDITION REPLACEMENT Tile Size No.Lin.Feet +� Trenoh Width Depth Number of Lines Seepage Bed: Length 25 Width 1;R1 Depth 4PR Tile Size 1A No. Lines 7 Seepage Pits Inside Diameter Liquid Depth 1, the undersigned, hereby osrtify that the percolation tests reported on this form were made by me or under my super- vision in a000rd with the proosdures and method speoified in Chapter H 62.20 (13), Wisconsin Administrative Code, and that the data recorded and location of test holes are correct to the best of my knowledge and belief. NAME T.. • -' TITLE ►1 a. -_, s or Print REGISTRATION NO. or MASTER PLUMBER LICENSE NO. - P4 - ,f3 r, ADDRESS Z1 -10 // DATE, �� SIGNATURE s� , f L is • ST. CROIX COUNTY ZONING DEPARTMEN� AS BUILT SANITARY REPORT Owner K QS Address City/Stat t , 5T CO UNTY 70NNGOFF) 4',' Legal Description: Lot Block Subdivision/CSM # Sec. -IL, T3(N -RAW, Town of PIN # _ 666 ° SEPTIC TANK -- DOSE CHAMBER -- HOLDING TAN INFORMATION: Tank manufacturer >� 6 i Size ST/PC lboo I., Clt)Setback from: House 66 / W ell 5 P/L t /LA � Pump manufacturer 6 � ` Model y Y Alarm location a , s (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM Type of system: /) Width / Len , - Setback from: House _ Vent - to air intake 166 �-- Nber of Trenches Well �1_ t..1� fr ELEVATIONS Description of benchmark Description of alternate benchmark ,,� Elevation /LC'� 5. Elevation ZC % 2 1 Building Sewer i ST/HT Inlet �i C �' ST Outlet PC Inlet , 5l t PC Bottom _ �s, 6- Header/Manifold 7 ge Top of ST/PC Manhole Cover Distribution Lines ( ) 7, Bottom of System Final Grade Date of instailation / Permit number 3 �-- State plan number (r, Plumber's signature License number D / 7 ate / lac, / Inspector Complete plot plan 4 N NOTICE: Please provide the following: • A plan view sketch showing everything within 100 feet of the system. • Two horizontal reference points to center of septic tank manhole cover. • Show alternate benchmark, if applicable. PLAN VIEW V / r INDICATE NORTH ARROW Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Count Safety and Buildings Division INSPECTION REPORT s01,4— GLNERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder' Na e: r j ❑ City ❑ Village Town of: State Plan ID No.: CST BM Elev.: Insp. BffElev.: BM Description: Parcel Tax No.: TANK INFORMATION r U ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Bench a 2.q Aeration Bldg. Sewer Holding St / Ht Inlet c TANK SETBACK INFORMATION St/ Ht Outlet TANKTO P/L WELL BLDG. Airl to ntake ROAD Dt Inlet Air I Septic N NA Dt Bottom Z77 Dpsi tr it NA Header /Man. &-6,5- Q17 8 Aeration NA Dist. Pipe 6-/y L9 7.77 Holdi Bot. System t 7 35 97 PUMP/ SIPHON INFORMATION Final Grade Manufacturer Z�x �Demand 9k. Model Number GU GPM 414, 6W TDH Lift// C Friction System�.s TDH j ,OC' t Loss Forcemain Length qo' Dia. F � °' Dist. To Well SOIL ABSORPTION SYSTEM BENCH Width p t Length ry 1 No. Of Trenches PIT No. Of Pits inside Dia. Liquid Depth MEN I N O / DIMENSION SETBACK SYSTEM TO P/ L BLDG WELL LAKE / STREAM LEACHIN nu ac ur INFORMATION Type Of CHAMB R / � Model � Numb System: G q/ --� OR UN) DISTRIBUTION SYSTEM Header/Manifold t� Distribution Pip () r yr r x Hole Size x Hole Spacing Vent To Air Intake Length "" Dia. Length Dia. Spacing !l t SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: TS: (Include code discrepancies, persons present, etc.) i lm Z / �✓ 31S',AA) //U&) 22-4 /t/ / ic, r r ." ��dLJe (p {�'��/- %S• l S/k w Gae 'f�l #1'( 'K� AI y 1'rt c y rrG Q /i ?V �d Plan J s ? Yes ba No , Use other side for additional information. L1� SBD -6710 (R.3/97) Date Inspector igna ure rt No ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: $ i E r a m # $ A n e = = # c € r n t t € � i „w u { f $ 5 _j, 3 z E t $ $ 3 r ; } $ $ i a x E R n i m t E _ J E $ _ r — m. i,.sa p� E S g # € YW $ E e - v " p 3 S 99 f k 7 # § t € e € r ' t � r e 3 e $ i a s s t 3, 01sconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Buildings Division Count Lt o T . CROIX INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitarlftftl:�P.: Personal information you provice may be used for secondary purposes [Privacy LRW, s.15.04 (1)(m)]_ Pg ELL K Na LVIN �Yf�t�0� Village ❑ Town of: State Plan ID No.: CST BM Elev.: 1` Insp. BM Elev.: B De scription: 1, lY ParceIWQ,1045 -70 -000 I D0 TANK INFORMATION ELEVATION DATA A9800552 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. eptic £/ ��n Be %a I to ?. / I_ Dosing (" / I �C1y. lob Aeration Bldg. Sewer Holding St /Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P / L WELL BLDG. Ventto ROAD Dt Inlet Air Intake eptic (�� r N NA Dt Bottom using NA Header /Man. q7 V Aeration Dist. Pipe P Holding A � . a R Bot. System 7 Q7 PUMP/ SIPHON INFORMATION q& a4n Final Grade Manufacturer Q✓� Demand Model Number GPM TDH Lift �,a L oss ristion System TDH! Ft or Forcemain Length q D r Dia. , �L` Dist. To well 50k ABSORPTION SYSTEM BE TRENCH width Length / No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth E I N r7 DIMENSION SYSTEM TO P/ L BL WELL LAKE /STREAM LEACHIN urer: SETBACK CHAMB R INFORMATION Type O (t r' OR UNIT Model er: System DISTRIBUTION SYSTEM Header /Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. Spacing• SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil E] Yes ❑ No [:]Yes E] No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: CYLON 21.31.16.315 NW NW 2205 210Th AVENUE . t 6 of e � rla" Ce Ve, Plan revision required? ❑ Yes ❑ No (� Use other side for additional information. I SBD -6710 (R.3/97) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: , I I I, Safety and Buildings Division V $C0/1S %I1 SANITARY PERMIT APPLICATION 20 W. Washington Avenue Department of Commerce In accord with ILHR 83.05, Wis. Adm. Code Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the system, on paper not less County than 81/2 x 11 inches in size. • See reverse side for instructions for completing this application State sanitary Permit Number ,3 Cov Personal information you provide may be used for secondary purposes E] Check if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Num er I. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATION /0 Pro pe w r Name Property Location Aj U, 14 PWI/4, S a T 3 , N, R (or) W Propert Owner's Mailing Address Lot Number Block Number o b -- Ci , to a Zip Code Phone Number Subdivision Name or CSM Number (7/ ,57 (. TYPE OF BUILDING 0 (check one) ❑ State Owned a it Nearest Road_�� > � ❑ Village Public JV1 or 2 Family -•• Dwelling- No. of bedrooms Town of d III BUILDING USE (If building type is public, check all that apply) Parcel Tax Number( 1 ❑ Apartment/ Condo _ S"-- 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/ Bar/ Dining 4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash 5 ❑ Hotel/ Motel 9 ❑ Office/Factory 13 ❑ Other: specify IV TYPE OF PERMIT (Check only one box on line A. Check box on line B, if applicable) A) 1. ❑ New 2 Replacement 3, ❑ Replacement of 4_ ❑ Reconnection of 5. ❑ Repair of an ______System - ____r�System ___ ____ __ ____ Tank Only_____ _______ Existing System ____ -___ Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non - Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 J Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPT SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade l sO RegyLed (sq-ft.) Proposed (sq. ft.) (Gal s1 ay /sq. ft.) (Min. /inch) / Elevation eet Feet Capacit VII. TANK in Ca allo g Total # of r Prefab. Site Fiber- Exper_ INFORMATION Gallons Tanks Manufacturers Name Concrete con Steel glass Plastic App New Exist in structed Tanks Tanks epUC an r4 eldin ❑ ❑ ❑ ❑ ❑ ft Pump Tan i0=n'ClT3?nber d — D!� ❑ ❑ ❑ ❑ ❑ VI11. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for install tion of the onsite sewage system shown on the attached plans. Plumb 's (P ) Plumb igna re: (No / PRSW No.: Business Phone Number: G o S /S- Plu er s Address (Street, C' tate, 2i e): Z o w IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate i ssue Issuing n Signature (No Stamps) Approved []Owner Given Initial Surcharge Fee) p Adverse Determination wo 1/ DIU / 1 eA.,- X. CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL: SBD- 6398 (R.11/97) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. n i 2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal an new criteria in the Yp Y p Y Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer / Renewal Form (SBD -6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608 - 266 - 3151.` - To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed: Il. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new /or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. County/ Department Use Only. Complete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump,performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. --------------------------------------------------------------------------------------------------- GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. I . A Safety and Buildings 1340 E GREEN BAY ST STE 300 SHAWANO WI 54166 sconsin Tommy G. Thompson, Governor Philip Edw. Albert, Acting Secretary Department of Commerce November 05, 1998 CUST ID No.273148 ATTIC POWTS INSPECTOR ZONING OFFICE UTGARD PLUMBING & HEATING ST CROIX COUNTY 110 N KILLER AVE 1101 CARMICHAEL RD AMERY WI 54001 HUDSON WI 54016 RE: CONDITIONAL APPROVAL APPROVAL EXPIRES: 11/05/2000 Identification Numbers. Transaction ID No. 185856 Site ID No. 163328 SITE: Please refer to both identification numbers, Site ID: 163328 above, in all correspondence with the agency. ST CROIX County, Town of CYLON NW, NW, S21, T31N, R16W KELVIN KJELLBERG FOR: Description: MOUND SYSTEM FOR KELVIN KJELLBERG Object Type: POWT System Regulated Object ID No.: 434546 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. The following conditions shall be met during construction or installation and prior to use: • The sewer line shall be located at least eight (8) feet from the well. • The combination (septic /pump) tank shall be located at least 25 feet from the well. • The sewer line shall be insulated pursuant to Comm 82.30 (11)(c). A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /installation/operation. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. Sincerely, DATE RECEIVED 10/28/1998 FEE REQUIRED $ 180.00 KEI A WILKINSON, POWTS PLAN REVIEWER FEE RECEIVED $ 180.00 Integrated Services BALANCE DUE $ 0.00 (715)524 -3630, FAX: (715)524-3633, M -F 7 AM - 3:45 PM KWILKINSON @COMMERCE. STATE. WI.US MOUND SYSTEM DESIGN J�R Residential Application INDEX AND TITLE SHEET Project KELVIN KJELLBERG Owner KELVIN KJELLBERG Address 2205 210TH AVE DEER PARK, WI. 54007 Legal Description NW NW S21 T31N R16 W Township CYLON County Oft* O 1 X Subdivision Name Lot No. Parcel ID Number 006 - 1045 -70 Q Plan transaction Number 1 8 5 5 8 5 1 =', 0 . vl.T. S. Cori(litionally Index and title sheet Page 1 P P � D Mound calculations Page 2 Mound drawings Page 3 DEPARTMENT OF COMMERCE Pres. disc. caics. and laterals Page 4 DIVISION OF SAFETY AND BUILDINGS TDH nd pump tank drawing Page 5 SEE CORRESPONDENCE Designer BRADY UTGARD License Number 220357 Signature Phone No. 715- 268 -6995 Date 10 -14 -98 Notice: Tampering with this file by unauthorized persons is prohibited. Deliberate modification will result in disciplinary action under s. 145.10, Wis. Stats. Personal information you provide may be used for secondary purposes (Privacy Law, s.15.04 (1)(m)]. SBD- 10462 -E (R.05M) Page 1 of 7— MOUND SYSTEM DESIGN Complete red boxes as necessary. 1000 gpd maximum design flow. Inch - pounds Metric Residential or commercial? R (r or c) (y or n) L Replacement system? Creviced bedrock site? n (y or n) Slope 2 % Wastewater flow rate 450 gpd 1703 Lpd Depth to limiting factor 20 in 50.8 cm In situ soil infiltration rate 0.5 gpd /ft' 20.4 Lpd /m` Contour line elevation 95.8 ft 26-15 m Use standard fill depths? I x OR esign epth? in dm Place X in box to use standard depths (24 and A +4 inclusive) OR specify design fill depth. Center or end manifold (o or e) Hole diameter 0.25 in 0.121, 01 o 0.25, 0.281, or r 0.313 0.313 inch only. Lateral spacing 3.00 ft Use 0 lateral spacing for trenches. Estimated hole space 4.00 ft Not a final calculation. Number of laterals 2 Pump tank elevation 85 ft Outside bottom of tank. Forcemain length 100.0 ft Forcemain diameter 2.0 in 1.5, 2, 3 or 4 inch only. 2.067 in Actual I.D. HOLE DIAMETER CONVERSIONS 118 =0.125 1/4 = 0.250 SYSTEM SOLUTIONS Inch- ounds Metric 8/32 = 0.156 9l32 = 0.281 Estimated daily flow 450 gpd 1703 Lpd 3/16=0.180 5/18=0.313 7132 = 0.219 Absorption ceN Design load rate 8r area 1.2 gpdW 375.0 ft` 34.84 m` Linear loading rate (LLR) 9.57 gpd /ft 118.7 Lpd /m Design width (A) 8.00 ft 2.44 m Cell length (B) 47.0 ft 14.33 m Depth of cell (F) 9.3 in 23.6 cm Sand filter Upslope fill depth (D) 16.0 in 40.6 cm Downslope fill depth (E) 17.9 in 45.5 cm Basal area required (gpd /infiltration rate) 900.0 ft 83.61 m Supporting components Topsoil depth 6.0 in 15.2 cm Subsoil depth at center 12.0 in 30.5 cm Subsoil depth at cell wall 6.0 in 15.2 cm End slope toe length (K) 11.06 ft 3.37 m Up slope toe length (J) 8.80 ft 2.68 m Down slope toe length (1) /J. /.f 11.10 ft 3.38 m Basal adjustment made. Total mound length (L) 69.12 ft 21.07 m Total mound width (W) 2 y j 27.90 ft 8.50 m Project: KELVIN KJELLB RG Transaction Number: 1 5 85 6 Page 2 of 7 r MOUND PLAN VIEW observation pipes (typal) �J 27.9 ft p A= 8.00 ft 2.44 m 8.51m �{ 47.0 ft 1 .33 m W :: J 8.80 ft 2.68 m ► K t = 11.10 ft 3.38 re K * 11.06 ft 3.37 m L L 69.12 ft 21.07 m typ. dbs. pipr (anchored semlilaly) I = down slope dimension" = absorption cell (AxB) J = up slope dimension = plowed am* (LxW) K = end slope dimension G"(152 mm) T MOUND CROSS SECTION D = 16.0 in d0.8 qn lateral topsoil w sub®otl cap E = 1,9 in 45.5 cm invert 97.63 ft _ _ F s "' 90 in 23.6 cm elev. 29 y::: F G = 12.0 in 30.5 cm ggTM C33 H = F 18.0 in 45.7 cm D E Sand Fib Sys. 97.13 ft y �' Slay. 29.61 m .80 ft contour 29.20 m elev. 2 % -- slope V = upslope fill depth plowed layer E w downslope fill depth Note: Absorption call media will consist F - absorpWn cell depth of aggregate and pipe with laWals G = subsoil + topsoil depth at cell wall centered across AxB media. The cell H = subsoil + topsoil depth at cell center media is covered with geotextile fabric. atsigner notes: Project: KELVIN KJELLBERG Transaction Number: 185856 Page 3 of } F. f i =a bX�t k. W as,,. . SY' pwi µ 7 I PRESSURE DISTRIBUTION CALCULATIONS Absorption cell Inch-pounds Metric Width (A) 8 I ft 1 2.44 1 m Length (B) 47.0 ft 14.33 m Lateral specifications Number laterals 2 Holes/lateral 12 holes Lateral length (P) 44.00 ft 13.41 m Hole diameter 0.250 in 6.35 mm Lat. dis. rate 13.98 gpm 0.88 Us Sys. dis. rate 27.96 gpm 1.76 Us Hole spacing (X) 48 in 121.9 cm Lateral diameter Pipe diameter Design options Design choice Designer must 1 in (25 mm) Place X in red "X" one choice 1 1/4 in (32 mm) X X box of chosen from the options 1 1/2 in (40 mm) X diameter. provided, 2 in (50 mm) X 3 in (75 mm) X Manifold diame Pipe diameter Des op t i ons Design choice Designer must 1 in (25 mm) "X" one choice 1 1/4 in (32 mm) x Place X in red from the options 1 112 in (40 mm) x box of chosen provided. 2 in (50 mm) x X diameter 3 in (75 mm) x 4 in (100 mm) x Distribution system contains: 2 Lateral(s) LATERAL DIAGRAM - END CONNECTION Place correct lateral diagram by clicking in one of the drawings at right and dragging the diagram into this area. Laterals centered over the A &'B dilmension Last hole drilled next to end cap end cap P r laterals are Wentioal IF �{--)� Holes drilled on the bottom of the lateral s equally spaced • oroe main oconneotio via tee or oross to manifold at -a poi Laterals & force main of PVC Soh 40 • - permanent end marker (per CONK Table 84.30 -5) Inch -pounds Metric Lateral length (P) 44.00 ft 13.41 m Lateral spacing (S) 3.00 ft 0.91 m Hole spacing (X) 48 in 121.9 cm Manifold length 3.00 ft 0.91 m Hole diameter 0.250 in 6.4 mm Lateral diameter 1.25 in 32 ] mm Forcemain diameter 2.00 in 50 mm Project: KELVIN KJELLBERG Transaction Number: 1 8 5 856 Page 4 of TDH and Pump Tank Drawing Total Dynamic Head Operational head 2.50 ft M m Vertical lift 11.83 ft m Are laterals the highest point in the Friction loss 1.36 ft m system? Yes 'W' here. C � Total dynamic head 15.69 I ft if no, what is the highest elevation Dose Volume downstream of pump? Dose is > 10 times lateral volume Forcemain drain Lateral void volume 6.8 gal 25.7 L back to tank? ("x' one) Minimum dose 112.5 gal 425.9 L x Yes Drain back 17.4 gal 65.9 L No Dose volume gal 491.7 L Typical Pump Chamber Layout In combination with state approved treatment tank. Tank construction as per Comm 83.20(3) WAC. approved manhole cover with weather proof warning label and locking device grade levels Junction box - — disconnect grade levels alternate 4' vent pipe electric as per NEC 300 and E outlet Comm 18.28 WAC location 18" (46 cm) min. wall of pump " approved chamber or outlet joint combination tank A Provide 1 /4' weep hole or ant - alarm on siphon device as necessary pump on B C Grade levels pump 85.8 ft y - pump tank manhole = 4 '(10 cm) off elev. 26.2 m A minimum above finished grade D - vent = 17' (30.5 cm) minimum above finished grade 85.0 ift Pump tank elevation 3 " (75 mm) of bedding under tank 25.9 1 m bottom of tank Tank manufacturer HUFFCUTT Pump tank capacity Pump tank volume 600 gal c c - t o Pump manufacturer WMILLER .20CAe'l Inches Gal n Pump model number se c A 358.1 'N B 2 am" c Alarm manufacturer ILEVEL 1 E C SW 9. Alarm model number JDLV I p D a&* iii Project: KELVIN KJELBF,�t� Transaction Number: i Page 5 of AL u I i J HEAD CAPACITY CURVE ~ �� b / MODEL "98" II I � I U 15 0 4 2 � 5 117 -11 1 \I'! \ U.S. GALLONS 10 20 30 40 50 60 70 80 LITERS 80 160 240 0 FLOW PER MINUTE TOTAL DYNAMIC NEADOLOW PER MINUTE EFFLUENT AND DEWATERING CAPACITY HEAD UNRSIMIN FEET METERS GALS LTRS 1 { 5 152 72 273 s1 231 -- — 10 3 05 I - 4 3/16 15 4.57 45 170 20 6.10 1 25 95 Lock Valve 23' 8 8 -- -- �l� n ... (J @�' sK�z CONSULT FACTORY FOR SPECIAL APPLICATIONS • Electrical alternators, for duplex systems, are available and • Variable level float switches are available for controlling single supplied with an alarm. and three phase systems. • Mechanical alternators, for duplex systems, are available with or • Double piggyback variable level float switches are available for without alarm switches. variable level long cycle controls. SELECTION GUIDE 1. Integral float operated 2 pole mechanical switch, no external control required. Standard all models - Weight 39 lbs. - '/2 H. P. 2. S ingle piggyback variable level float switch or double piggyback variable level, gg gem V11ro' lection float switch. Refer to FM0477. Model Volts -Ph Mode Am q�4 SDuplex 3. Mechanical alternator 10 -0072 or 10 M98 115 1 Auto 9,4 1 — 4. See FM0712. for correct model of Electrical Alternator, 'E -Pak " 5. Control switch 10 -0225 used as a control activator, specify duplex (3) or (4) N98 115 1 Non 9 2 3 or 4 it 5 float system. D98 230 1 Auto 4 1 6. Four (4) hole "J - Pak ", junction box, for watertight connection or wired - in E98 230 t Non 4. 2 3 or4&5 simplex or duplex operation, 10 -0002. 7. Two (2) hole "J- Pak ", for watertight connection or splice. CAUTION For information on additional Zoeller products refer to catalog on Comlrnalion Starter, FM051 4: All installation of controls. protection devices and wiring should be done by a qualified codes should Piggyback Variable Level Swilches, FMO477. Electrical Alternator, FM0406, Mechanical Altema- roost recent National Electnc t COde a (NECl f ind the occupai onal y and Health Act 04 Ior, FM95, Alain, Package, FM0513: SumplSewage Basins, 1`1010467, and Simplex Control Box, ( OSHA) ost re FM0732. e RESERVE POWERED DESIGN For unusual Conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL To: P.O. BOX 16347 e_otuswie, ICY 40256 -0347 Nartulacturersol. . SHIP La 40 3280 Old Mi ll e rs Ldln O svdfe, KY ao2 •s QvQUrr Pins ,$ivCE /9,79 ' PUMP ICY (502)77 AX�502�77 74 4 - 3624 ' - - - - - -- - 2 af 7 . l ao-035 7 kA ob N ui , N sat �r ti , l to w town Of Cj tbn i N 1" LIp' r 3 \ a4 S � � S 3o 3 8oa[,p� 18 5 8 5 6 ►�`- Page Wisconsin Department of Industry, S O 1 L AND SITE EVALUATION REPORT 1 of 3 Labor and Human Relations Division df safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but St. Croix not limited to vertical and horizontal reference poin ' Tmctiop and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and ;di, n�16', � rest road:, 006 - 1045 -70 APPLICANT INFORMATION -PLEAS ,9 AL FORMATI�,N R IEWED Y ATE S 1t. c l u PROPERTY OWNER: PROPERTY LOCATION Kelvin Kj ellberg ! . OVT. LOT NW 1/4 NW 1/4,S21 T 31 AR 16 I r) W PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # 2205 210th. Ave. BT cROix j na n a na CITY, STATE ZIP Cd? E PHON �, ^V ❑CITY ❑VILLAGE MOWN NEAREST ROAD Dee Park, W I. 54007 ` l7 '� —53 Cylon 210th. Ave. [ ] New Construction Use [K ] Residential / rd 3 [ ] Addition to existing building ( Replacement [ ] Public or commercial describe Code derived daily flow 450 gpd Recommended design loading rate .5 bed, gpd /ft .6 trench, gpd /ft Absorption area required 375 bed, ft 375 trench, ft Maximum design loading rate .5 bed, gpd /ft .6 trench, gpd/ft Recommended infiltration surface elevation(s) 97.08 ft (as referred to site plan benchmark) Additional design / site considerations system el. based on contour line of el. 95.75' Parent material glacial drift Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL I MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem I ❑ S ®U EIS ❑ U 1 ❑ S ® U ❑ S CU [Is ®U [Is ® U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench .................. ................. .................. ................. 1 0 -9 10yr4 /3 none 1 2msbk mfr cs 2f .5 .6 .:'...1.... 2 9 -22 10yr4/4 none sl 2msbk mfr gw if .5 .6 Ground 3 22 -27 10yr4 /4 c2d 7.5yr5/6 sl lcsbk mfr gw na .4 .5 elev. 9 4 27 -40 7.5yr4/4 ced 7.5yr5/6 scl lcsbk mfr na na .2 .3 Depth to limiting factor 22" Remarks: Boring # 1 0 -10 10yr3 /3 none 1 2msbk mfr cs 2f .5 .6 =' 2 10 -20 10yr4 /4 none sl 2mgr mfr gw if 3 20 -36 7.5yr4/4 c2d 7.5yr5/6 sl lcsbk mfr gw na .4 .5 ................. Ground elev. 4 36 -44 10yr5 /4 c2d 7.5yr5/6 sil M na na na np .2 9 6.25 ft. Depth to limiting factor 20" Remarks: CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -6200 Address: 1554 200th. Ae., New Rich2jond WI 54017 Signature: Date: CST Number: m02298 5 -14 -98 PROPERTY OWNER Kelvin Kjellberg SOIL DESCRIPTION REPORT Page 2 of 3 PARCEL I.D. # 006- 1045 -70 Depth Dominant Color Mottles Structure GPD /ft Boring # Horizon Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench ...... <.: 1 0 -10 10 r3/3 none 1 2msbk mfr cs 2f .5 .6 2 10 -20 10yr4 /4 none sil 2msbk mfr 9w if .5 .6 Ground 3 20 -28 10yr4 /4 c2d 7.5yr5/6 sil lcsbk mfr gw na .2 .3 elev. 9 4 28 -45 7.5yr4/4 c2d 7.5yr5/6 scl 2csbk mfr na na .4 .5 Depth to limiting factor Remarks: Boring # .................. Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # � Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) A STEEL'S SOIL SERVICE Gary L. Steel 1554 200th Ave. CSTM2298 Kelvin Kjellberg New Richmond, WI 54017 MPRSW -3254 WIWI S21- T31N -R16W (715):246 -6200 town of Cylon 40 acres N 1 " =40' BM.= top of well C el. 100' Alt. BM.= peg in power pole @ el. 98.05' z2-`7 88' o t t'_°o ✓ 4u. roll nG N PW jA p W p -1� IA e GAry L. Steel 5 -14 -98 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer kdjj-L Mailing Address jo Property Address (Verification required from Planning Department for new construction) City /State - Parcel Identification Number t LEGAL DESCRIPTION Property Location !!2 X 1 /4, AZA y4, Sec. T , 3/ N -R_ZLW, Town of Subdivision Lot # Certified Survey Map # , Volume , Page # Warranty Deed # �5�.�3 , Volume Page # Spec house ❑ yes kno Lot lines identifiable yes ❑ no SYSTEM MAINTENANCE v \ Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restrictedplumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. 7 7 / SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. c. SIGNATURE OF APPLICANT DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed ' DOCUMENT NO WA �v�, DEED RECORDING INFORMATION 53333N Y �sF. `�� �� :. St t�OIX CO,, WI THIS DEED, made between James Kjellberg and Janice K K ellberg, Padd f or Reootd s husband and wife, as joint tenants and to the survivor thereof as strvivorship j E P 1 192 marital property, Grantors, and Kelvin A. Kjellberg, a single persew Grantee, 9.30 A M WITNESSETH, That the said Grantors, for a valuable cognation of one at dollar and other valuable consideration conveys to Grantee the foiiowing described 3' w - (.&qA., real estate in St. Croix County, State of Wisconsin: of DOOM The Northwest 1/4 of the Northwest 1/4 of Section 21, Township 31 North, Range //� 16 west. - ....... ................. RETURN TO: � LIZA5 Tax Parcel No: This is not homestead property. Together with all and singular the hereditaments and appurtenances thereunto belonging', and Grantor warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except Easements, highways, utility rights and reservations of record, and will warrant and defend the same. Dated this 2-2) day of �'1 l� - 1995 a (SEAL) (SEAL) • Ja s K'ellbe � t7 (SEAL) (SEAL) • Janice M Kiellbers AUTHENTICATION ACKNOWLEDGEMENT Signature(&) of STATE OF WISCONSIN } } ss. ST. CROCK COUNTY } authenticated this _ day of 19_ 25th personally came bcrom me this day of AUqUQJ 19 95 , the above named lames aelittcaand • Janice K'ellbe TITLE MEMBER STATE BAR OF WISCONSIN (If not' to me known to be the who executed the foregoing instrument and authorized by 4x• Was. Sots.) P • aeknowledgedthe same. � y......`:' THIS INSTRUMENT WAS DRAFTED BY: / ,;� '• . °; k, BAKKE NORMAN, S.C. ►a,, ; • - NEW RICHMOND, WISCONSIN ,O Pu (� St. C roix •r dye^►''scPM 1 •Names of persons signing in any capacity should be typed or printed below their My Commission is perrtaaesa- (If not, mate signatures. ID M (,